Laparoscopic management of ureteral lesions in gynecology.
OBJECTIVE
To investigate the outcome of laparoscopic repair of ureteral injury in laparoscopic gynecologic surgery.


METHODS
Prospective trial.


METHODS
University hospital.


METHODS
Forty patients with a ureteral lesion in laparoscopic surgery between 1991 and 2007.


METHODS
Laparoscopic ureteral repair, laparoscopic-assisted or blind stent insertion.


METHODS
Treatment outcome of ureteral lesion analyzed by type of injury, time of diagnosis, and management.


RESULTS
In 4,350 consecutive laparoscopic gynecologic interventions, 42 lesions occurred, 5 during hysterectomy, 1 during adnexectomy, and 36 during deep endometriosis surgery. In the latter group (n = 1,427), the incidence was 1.5% and 21% in women without and with hydronephrosis, respectively. In eight women in whom a stent was inserted after surgery without laparoscopic guidance, five were uneventful and three needed a second intervention. In all 34 women in whom a laparoscopic repair over a stent was performed, the outcome was uneventful, whether diagnosed and treated during surgery (n = 25) or after surgery (n = 9).


CONCLUSIONS
Laparoscopic repair over a stent was uneventful for all lacerations, transections, and fistulas, whether performed during or after surgery, and was superior to blind stent insertion. In women with hydronephrosis and deep endometriosis, a preoperative stent insertion seems to be mandatory.
De Cicco
Carlo
C
Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Obstetrics and Gynecology, University Hospital A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy. Electronic address: carlodecicco@gmail.com.
Schonman
Ron
R
Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium.
Craessaerts
Marleen
M
Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium.
Van Cleynenbreugel
Ben
B
Department of Urology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium.
Ussia
Anastasia
A
Department of Obstetrics and Gynecology, Villa Giose, Crotone, Italy.
Koninckx
Philippe Robert
PR
Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Obstetrics and Gynecology, University Hospital A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery; D012189:Retrospective Studies; D015607:Stents; D025321:Surgery, Computer-Assisted / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome; D014513:Ureter / Q000293:injuries / Q000601:surgery; D014515:Ureteral Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery*; D014546:Urinary Catheterization / Q000379:methods / Q000706:statistics & numerical data